What’s the nature of mental illness?

Creating or
Identifying Mental Illness: what American psychiatric definitions of illness do

by Dena T. Smith

Jan 11, 2010

The New York Times Sunday
Magazine featured an article (a preview of a book) by Ethan Watters about the
globalization of American concepts of mental illness (linked below). In short,
along with our flavored lattes, burgers and GAP jeans, American concepts of
illness are spreading across the globe. I would argue they have spread and are
relatively well-integrated into the majority of societies’ understandings of a
wide range of symptoms. There are very few places untouched by American
conceptualizations of mental disorders, particularly those of the American
Psychiatric Association. Relatively ignored in this shortened version of
Watters’s argument are the contributions of Sociologists of mental health in
describing the construction of illness and how illness conceptualizations/categories
spread and affect both individuals diagnosed with the myriad psychiatric
conditions now considered biological disorders by American Psychiatry as well
as cultures and societies more generally once these concepts become commonly
accepted.

A version of this article appeared in print on January
10, 2010, on page MM40 of the New York edition.

AMERICANS, particularly if
they are of a certain leftward-leaning, college-educated type, worry about our
country’s blunders into other cultures. In some circles, it is easy to make
friends with a rousing rant about the McDonald’s near Tiananmen Square, the
Nike factory in Malaysia or the latest blowback from our political or military
interventions abroad. For all our self-recrimination, however, we may have yet
to face one of the most remarkable effects of American-led globalization. We
have for many years been busily engaged in a grand project of Americanizing the
world’s understanding of mental health and illness. We may indeed be far along
in homogenizing the way the world goes mad.

Adults with past-year
mental illness are more than three times as likely to use and abuse drugs as
those who have not experienced mental illness in the past 12 months. About 20
percent of U.S. adults aged 18 or older suffered from a diagnosable mental,
behavioral, or emotional disorder in the past year. However, more than 60
percent of these 45.9 million individuals failed to receive mental health
services during that period.

Considered to be at the
high-functioning end of the autism spectrum, Asperger syndrome has become more
loosely defined in the past 20 years, by both the mental health profession and
by lay people, and in many instances is now synonymous with social and
interpersonal disabilities. But people with social disabilities are not
necessarily autistic, and giving them diagnoses on the autism spectrum often
does a real disservice. … Eventually, biological markers, now in the beginning
stages of development, will help in separating autism-spectrum disorders from
social disabilities. For example, researchers at the University of Pittsburgh Medical Center have recently developed
three-dimensional brain scans that look at brain wiring. In preliminary studies
people with autism-spectrum disorders appear to have too much wiring and
disorganized wiring in areas involved with language acquisition.